| NPI | 1356902217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TN 12030) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401418162) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2022-11-01 |